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Falls

Falls are the leading cause of unintentional home injury and death in the US. [1] Older adults are by far the population at greatest risk for unintentional falls with over one-third of all seniors age 65+ falling every year. [2] Children younger than 5 are the other demographic group with high rates of falls. [1, 3] Interventions have been tested among populations of community-dwelling older adults, as well as seniors living in nursing homes and residential care facilities; some of these interventions have been shown to be effective in reducing the incidence of falls. The challenge will be to disseminate these proven strategies to a rapidly growing population of older adults. [1]

Morbidity and mortality

Deaths

  • Falls are the leading cause of unintentional home injury deaths accounting for 33% of fatalities. [1]
  • In 2002 more than 16,000 people died from unintentional injuries due to falls. [4]
  • The rate of deaths associated with falls increases substantially with age, with the majority of deaths occurring among those over 65 years of age. [1]
Injuries and Emergency Room Visits
  • Fall-related injuries are the overall leading cause of non-fatal unintentional injuries for people of all ages. [4]
  • Falls account for more than 40% of all nonfatal home injuries. [1]
  • The two highest risk age groups are children under age 5 and older adults over age 70. [1]
  • An average of 3.8 million residential fall injuries resulting in an emergency department visit occur every year. [1]
Where and when the deaths and injuries occur
  • More than half of all unintentional falls resulting in death or nonfatal injury occur in the home. [1]
  • The majority of child falls occur between noon and early evening, the most common playtime for children. [3]
  • For children, the most severe falls are general associated with three products: baby walkers, windows, and play equipment including trampolines. [3]
  • In 2002, almost 4,600 children ages 4 and under were treated in hospital emergency rooms for baby walker-related injuries. Falls down stairs have been implicated in 75% -96% of baby walker-related falls. [3, 5]
Populations at disproportionate risk
  • For non-fatal injuries and emergency department visits, children under the age of 5 and seniors over age 70 have the highest rates of unintentional falls. [1]
  • Males are more than twice as likely as females to die from fall-related injuries. [1, 3]
  • Children at greatest risk are preschoolers and children with disabilities that limit mobility. [3]
  • Children from low income families and African American and Hispanic children are all at increased risk of fall-related injuries. [3]
  • Among older adults, those with the following risk factors have increased risk of falls: lower body weakness; problems with balance and walking; taking four or more medications or any psychoactive medications; cognitive impairment; arthritis; Parkinson's Disease; visual impairment; or a history of stroke. [2]
Effectiveness of injury interventions

Older adults

  • Interventions that have shown effectiveness in reducing fall-related injuries among older adults include: individually prescribed exercises that target muscle strength and balance, including Tai Chi; professionally prescribed home hazard assessment with modification for older persons with a history of falls; withdrawal of psychotropic (e.g. anti-depressants and hypnotics) medications; and multi-factorial risk assessment and targeted treatment of both individual deficits and home hazards. [6, 7]

Children

  • Window guards have been shown effective at preventing falls. New York City passed a regulation in conjunction with an education and window guard distribution program that resulted in a 50% reduction in window-related falls, and a 35% reduction in window-related fatalities. [3, 8]
  • Data show that protective surfaces (versus cement or asphalt) under play equipment can prevent the incidence and reduce the severity of fall-related injuries. [3, 9]
  • The current voluntary standard designed to improve the safety of baby walkers and reduce related injuries went into effect in June 1997. These standards include having walkers be too wide to fit through a standard doorway and features which stop the walker at the edge of a step. However, there has been no formal effectiveness evaluation of the regulation at preventing fall-related injuries. [3, 5]
Cost and cost-effectiveness data
  • Falls cost by far the most money to society in medical care costs. [1]
  • On average, unintentional falls cost $100 billion annually in medical costs and account for 45 percent of the total costs for medically treated unintentional home injuries. [1]
  • Falls account for one quarter of all childhood unintentional injury-related costs. [3]
References
  • 1. Runyan, C. and C. Casteel, eds. The State of Home Safety in America: Facts About Unintentional Injuries in the Home. 2nd ed. 2004, Home Safety Council: Washington. DC.
  • 2. National Center for Injury Prevention and Control. Falls and hip fractures among older adults. 2005. http://www.cdc.gov/ncipc/factsheets/adultfalls.htm. Accessed on September 2, 2005.
  • 3. National SAFE KIDS Campaign. Falls fact sheet. 2004, National SAFE KIDS Campaign: Washington, DC.
  • 4. National Center for Injury Prevention and Control. Web-based injury statistics query and reporting system (WISQARS). 2005. http://www.cdc.gov/ncipc/wisqars. Accessed on August 31, 2005.
  • 5. American Academy of Pediatrics. Injuries associated with infant walkers. Pediatrics, 2001. 108: p. 790-792.
  • 6. Gillespie, L., et al. Interventions for preventing falls in elderly people (Cochrane Review). 2003, The Cochrane Library: Oxford.
  • 7. Moreland, J., et al. Evidence-based guidelines for the secondary prevention of falls in older adults. Gerontology, 2003. 49: p. 93-116.
  • 8. American Academy of Pediatrics. Falls from heights: windows, roofs, and balconies (RE9951). Pediatrics, 2001. 107: p. 1053-1056.
  • 9. Chalmers, D., S. Marshall, and J. Langley. Height and surfacing as risk factors for injury in falls from playground equipment: a case-control study. Injury Prevention, 1996. 2: p. 98-104.
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